goodduck

[cirrhosis complication]
four major -- portal hypertension
1. EV bleeding 
2. hepati encephlopahty
3. hepatorenal syndrome
4. SBP
minor 
1. portal hypertensive gastropathy
2. splenomegaly
3. ascites
4. coagulopathy
5. HCC

EV bleeding 
S&S: bleeding...
Dx: endoscope (must confirm bleeding loaction)
Tx:   (a) never EV bleeding: propranolol/Nadolol
        (b) active bleeding -> keep hemodynamic stable -> endoscope confirm ->
              medical (vasopressin / octreotide / somatostatin)
              endoscope(ligation / sclerosis)
              surgical (TIPs,shunts)
        (c) prevent recurrent: propranolol / nadolol (HR 25% or HVPG 12mmHg/20%)

hepatic encephalopathy
S&S: mental status + Asterixis
Dx: ammonia "highly suggest", not diagnostic! Dx by "exclusion"
       acute/chronic alcooholism/intoxication, sedative overdose, Wernick/Korsakoff's, Wilson's disease, 
       SDH, hypoglycemia, meningitis, metabolic brain...etc
Tx: lactulose

SBP
S&S: peritoneal sign, abdominal pain,fever, ileus...etc
Dx: PMN >300
Tx: cefotaxime

hepatorenal syndrome
S&S: hypotension, hyponatremia, progressive oligouria, worsen azotemia
Dx: 1. serum Cre increase > 1.5mg/dL  2. fail to volume expansion Tx
       2. urine Na < 5 mmol/L                       4. exclusion other etiology 
Tx: Nil

[Ascites]
1. hypoalbumin
2. portal venous pressure increase
3. "underfill" -> effecive intravascular volume decrease -> renal perfusion decrease ->
    RAAS -> aldosterone -> Na retension